Training materials for teachers of learners with severe, profound and complex learning difficulties

Foetal alcohol spectrum disorder (FASD) is the most common preventable cause of learning disability/difficulty in the UK It is caused by heavy maternal alcohol consumption in early pregnancy, either chronic daily use or binge drinking. A number of factors may exacerbate the effects of alcohol, including:

• The pattern and timing of alcohol consumption
• The stage of foetal development, and
• Social behavioural factors, eg poverty and smoking.

It is estimated that that the current prevalence of FASD in populations of younger school children may be as high as two to five per cent in the USA and some western European countries (May et al, 2009).

For a diagnosis, four criteria must be met:

• growth deficiency
• characteristic facial features
• central nervous system damage, and
• confirmed alcohol exposure.

Canadian research (O'Malley, 2007) has shown that many children with FAS are initially misdiagnosed with ASD, Asperger syndrome, ADHD, or obsessive compulsive disorder (ODD).

The developmental profile of children with FASD is variable. Expressive language may be in advance of their actual age and their reading skills may be chronologically appropriate. In areas such as social skills and emotional maturity they may be performing at half their developmental age.

Mathematical and numerical concepts are particularly challenging for these children in that, for some, the parietal lobe of the brain, which controls numeracy and computational activity in the brain may have significantly reduced functioning.

Characteristics of FAS are individual to each child depending on timing and dosage of maternal alcohol consumption. However, in general, children may:

• have difficulty predicting and understanding the consequences of actions
• despite a good vocabulary, struggle to understand what is said to them
• have difficulty in separating fact from fantasy
• display behaviours which will need support, such as lying, stealing, temper tantrums
• have delayed physical, emotional and cognitive development (delayed developmental milestones)

• be easily influenced by others
• have poor impulse control, hyperactivity and poor memory
• experience sensory processing difficulties
• have social communication difficulties, particularly in the areas of interpreting the actions of others and in understanding how to respond in social situations; this is due to their impulsivity and lack of inhibition, and may lead to inappropriate sexual behaviour when older
• have dietary and feeding difficulties/small stature/health problems such as frequent and persistent colds, visual and hearing impairments.

In a study by Carpenter (2011), teachers were asked to identify the challenges to the classroom learning environment presented by children with FAS. Here are the top ten:

• Hyperactivity
• Short attention span
• Erratic mood swings
• Poor memory
• Lack of social skills
• Difficulties with auditory/vocal processing
• Difficulties with visual sequencing

• Sensory integration difficulties – particularly lack of coordination
• Poor retention of task instructions, and
• Difficulties with numeracy – mathematics.

The brain damage associated with FAS cannot be reversed so teachers use a variety of approaches to optimise childrens' learning. Carpenter's research led to the identification of ten effective teaching responses to the ten learning needs profiled above:

• A calm learning environment, free from clutter
• Focused tasks presented in small steps
• Personal space for children with plenty of support and praise
• Visual structuring
• Scripting/role play
• Short, key, information-carrying instructions
• Visual clarity and graphic simplicity

• Frequent, short exercise programmes during the day
• A breakdown of tasks with visual and tactile clues and time given for the child to complete the task, and
• Multi-sensory learning which gives messages through a variety of sensory pathways.

Carpenter (in press) argues that children with complex learning disabilities such as foetal alcohol syndrome are presenting new profiles of learning need that cannot be accommodated through traditional curriculum frameworks. He argues for new and innovative 'practitioner-led, evidence-based approaches to teaching such children that generate personalised curriculum pathways'.

This requires:

• Structured opportunities for the professional development of school staff to ensure that new professional capacities are supported, and
• Effective teamwork involving the child, its family and all the professionals working with them.